MHA Opposes Changes to “Public Charge” Immigration Rules

In a strongly worded letter to the U.S. Department of Homeland Security (DHS) sent last Friday, MHA outlined its opposition to a proposed federal rule that MHA says will destabilize Massachusetts healthcare by, among other things, making it harder for immigrants to access medical care. MHA said the rule also would have the unintended consequence of inhibiting medical care for immigrants’ family members, many of whom may be children and U.S. citizens.

At issue is how the rule re-defines who could be determined a “public charge” of the government and therefore potentially ruled inadmissible for immigration into the U.S. A public charge is an individual who is likely to become “primarily dependent on the government for subsistence.” For the past 20 years, this has been limited to receipt of cash assistance and using long-term care at the government expense.

Now, under the proposed rule change, the federal government is proposing to use healthcare programs relating to certain Medicaid benefits and Medicare drug subsidies as part of the evaluation process. Other benefits such as Supplemental Nutrition Assistance Program (SNAP) and housing programs are also proposed to be included in the “public charge” assessment. The proposed rule would also evaluate whether an immigrant would likely to use these services at any time in the future, and include factors based on income, assets, age, and health.

“Massachusetts hospitals and healthcare providers are very concerned that the proposed rule will dissuade thousands of low-income Massachusetts residents from seeking health coverage,” MHA wrote in its letter. “An expansion of [the public charge] definition to include healthcare benefits such as Medicaid will likely mean many immigrants will withdraw or forgo applying for health coverage programs. Worse, many may also forgo even seeking medical care if they believe it will be a potential negative factor in their future immigration status.”

MHA added that aside from Medicaid, “The proposed inclusion of SNAP and federal housing support in the immigration status evaluation process will have a negative influence on people seeking these needed supports and will ultimately lead to unfavorable health consequences.”

While the new rule is aimed at those in the immigration pipeline, MHA said it could have a “chilling effect” on those not even affected by public charge rules. MHA wrote: “We believe the rules will create a fear that their own immigration status or that of a family member will be affected by their participation in federal or state programs, which will cause these immigrants to forgo or withdraw from health coverage programs. Immigration statuses and rules are complex, making it difficult for individuals to understand whether these rules would apply to them. Also, a ‘family’ can include members directly affected by the policy as well as those that are not, including U.S. born children. Many families will see this change as a choice between keeping their families whole or keeping them healthy.”

In addition to MHA’s comments, numerous hospitals, healthcare providers, and others concerned with healthcare access across Massachusetts have submitted comment letters. In an advisory to its members informing them of the proposed rule and encouraging comments to DHS, MHA also included resource documents hospitals can use to direct individuals concerned about their immigration status to immigration experts in their communities.